The Hidden Dangers of Medicare Advantage Plans for Social Security Recipients

[William769]

It’s open enrollment time for Medicare eligibles. All those TV ads and direct mail pieces, some of which come from hospitals, urging you to switch to a Medicare Advantage Plan from the traditional Medicare Part A and B.

Medicare Advantage plans, also known as Medicare Part C, have gained popularity recently as an alternative to traditional Medicare. These plans offer enticing benefits such as low premiums and additional coverage, making them seem like an excellent choice for Social Security recipients. However, beneath the surface, hidden dangers and drawbacks may make Medicare Advantage plans a bad choice for those relying on Social Security benefits.

As a retired healthcare executive, if you are considering enrolling for the first time or switching from traditional Medicare, don’t do it. It is a shell game that gives providers some reimbursement certainty and cost control for CMS. But, as the healthcare consumer, you still pay the deductibles and co-pays just like traditional Medicare Part A and B.

While it sounds great that you get all these additional services on Medicare Advantage, are you financially prepared to spend thousands of dollars out of pocket for what Medicare Advantage does not pay?

https://www.msn.com/en-us/money/retirement/the-hidden-dangers-of-medicare-advantage-plans-for-social-security-recipients/ar-AA1jl4ko?ocid=msedgntp&cvid=190e49ec9d274306b90cad5a5cf616c8&ei=12

[chillfactor]

1. Thank you for the info!

I have to renew my Medicare coverage. I am being besieged with Medcare Advantage promos and am sick and tired of them. I have not heard one positive comment in switching to an Advantage plan. Will stick with my regular Medicare coverage.

[William769]

2. Good plan.

I will always keep my original Medicaare.

[Mister Ed]

47. My strong advice to all is to ignore all promos and go straight to the source: Medicare.gov.

The find & compare feature on the website has been a great help to me.

[brush]

103. IIRC Medicare A and B only pays 80% and the rest is up to the you, which is where...

theoretically the advantage plans come in to help pay the additional 20%. That was my understanding when I took a workshop on it and then signed up. As we all know medical bills can be very high, especially hospitalization. Advantage plans for part C are worth investigating on Medicare's web site.

[Duncan Dem]

3. What a ripoff

Where we live no health care provider accepts part c.

[Delphinus]

42. Wow!

It's a good thing you know that so you can keep your traditional Medicare A & B.

Welcome to DU!

[leftstreet]

4. DURec

[mackdaddy]

5. I am getting over 10 robo calls a day to switch to an Advantage plan.

I stopped answering my land line and have the answering machine on 2 rings. Almost all are now just hang ups.

If I do answer and eventually someone does come on the line, they start asking about my medicare insurance and how there are SSOOO many things I am missing out on. Like my medical insurance is my business, not some cold call BS that can barely speak english.

Which of course is true unless you actually have to use your medical insurance.

I wish I could get them to stop calling.

[RoadRunner]

6. The "Advantage" part means them, not us

There are lots of articles about how Medicare Advantage plans overbill Medicare and at the same time refuse to pay for services covered by Medicare. I would like to see them gone but would really, really like to see Joe Namath gone from my TV.

[erronis]

9. I must be in the huge minority here. I don't have a T.V. and don't get this crap (Joe Namath/etc.)

I also don't get 99% of the political ads/lies.

I get my entertainment and news from trusted internet sources. Granted, I'm not big into what's hot in the entertainment world. Don't care about televised sports either. Boring and happy!

[hunter]

14. Same here. But they've turned the phone number I've had for 30+ years to shit.

.

[airplaneman]

68. Yes I remember when it was exciting to get a phone call. Now I dread all calls n/t.

[Grammy23]

48. I want "Martha" gone from my TV

Permanently, please!

And if they had to have a Martha, why is she a petulant, Stubborn old geezer?? Why have such a stereotype? Did they think that’d be cute? Did it ever occur to the geniuses behind that ad campaign how insulting that ad is to every Medicare eligible customer?

Oh, and by the end, Martha is eating out of the hand of the faceless voiceover. Another insult to any of us seniors with two brain cells left to rub together.

Still have my original Medicare parts A & B plus an expensive supplement, but worth every penny. We have not had a single bill (or co-pay) even after two knee replacements and countless other office visits, lab tests, x-rays, MRIs. Plus stroke hospitalization for spouse. Not one bill. Not changing to an advantage plan no matter how many so-called perks they offer. It is a trap. Don’t do it.

[RoadRunner]

49. Ageism sucks, and it's everywhere

I applaud you on the supplement policy, sounds like a good one. I’m retired from academics and the university’s insurance still covers me. It’s simple, no gotchas or fine print, it just pays everything Medicare doesn’t.

There’s some excellent books out right now on ageism, like "Honest Aging", which I’m reading now. You’re right, ageism is insulting and hurtful.

[oregonjen]

90. Thank you! Ugh, that "Martha" stereotype is incredibly insulting.

Every time I see that commercial, it makes me nauseated. I wonder what the actress thought when being dressed in that hideous shirt and huge glasses.

[MOMFUDSKI]

7. There is a max out of pocket for my

Advantage Plan. I also have the ability to switch to regular Medicare in the first 3 months of 2024. I was also able to switch to a PPO for 2 months a few years ago so I could pick the eye doctor I wanted to do my cataracts. Being diabetic allows me a better Advantage Plan. I have a great self-employed agent/broker who looks out for me.

[SickOfTheOnePct]

13. I'm not old enough for Medicare yet

So I haven’t really looked at the Advantage plans, but plenty of people I know have an Advantage plan and love it.

A few folks here on DU like their Advantage plans too, but every few months the posts about how awful Advantage plans start up.

[Silent Type]

16. As of 2023, more (51%) Medicare beneficiaries are covered by Advantage Plans than original Medicare.

What those who condemn Medicare Advantage fail to realize is that what is right for them is not necessarily right for others. I think choice is good.

I have traditional Medicare, but I can foresee the day I can no longer afford a supplement and drug plan.

[JayDem]

55. Please think about it Silent Type

Both the drug plan and the supplement plan are "FOR PROFIT" plans. In this context, profits that they make would otherwise go to care for patients. That is why supplement rates tend to grow so high, so fast. The Medicare Advantage plans are really Medicare Disadvantage plans. They cost the Medicare program much more money than just giving that money to Traditional Medicare to expand services. Additionally, if you should chose to go to a Medicare Advantage plan, then decide to try to return to Traditional Medicare, depending on the state you live in you may be required to undergo Underwriting to get your supplement which can result in even higher rates.

There is much more I could say, but let this suffice for now. Please be cautious in this decision.

[Silent Type]

63. May well be true for you. Others are different. Do you really think you are smarter than

all 51% of Medical beneficiaries?

[JayDem]

89. Not smarter

I make no claims to be smarter than anyone but I've studied this for years. The 51% you mention have been heavily advertised to for years by the Disadvantage Plans while Traditional Medicare is not allowed to advertise the disadvantages thereof. The public has been greatly misinformed about the true costs of these plans for years. The underlying reason for this all goes back to who the funders of legislation are in this country.

[pazzyanne]

51. I am one of those people who loves my PPO Advantage plan (through Blue Cross/ Blue Sheild).

Note that I have a PPO plan, and will NOT get an HMO ever. But I have a fatal auto-immune disease with treatment plans in excess of $60,000 a year. I have a cap of $5,000 a year with my PPO, and have no trouble with prior approvals. With straight Traditional Medicare my share of the payment would be $12,000 plus per year plus higher copays. Add to that the fact that I live on Social Security only. I cannot live on my SS with Traditional Medicare!

[moonscape]

119. Yes, without a supplement one pays the

20% (your 12k). My supplement (2400/year) covers the 20% and I have zero co-pays on Original Medicare.

Like you, I have health issues, cancer on continuous treatment as one of them. For the last 8 years I have had zero co-pays for any of my surgeries, hospitalizations, treatments, scans, etc, only insurance premiums. Not a single other out- of-pocket cost.

Fortunately we’re both happy with our plans. Only thing better would be not needing to use them at all

[pazzyanne]

121. For sure! nt

[GoneOffShore]

86. 11 years ago I asked my insurance person about Medicare Advantage. "You mean Disadvantage", was

their response.

It's designed to weaken Medicare and take advantage of the patient.

[Liberal In Texas]

32. If you have "Advantage" you must know the term "Prior Authorization."

It's a term you never hear with real Medicare.

Prior Authorization means it may take months to get approval for a procedure that you need. If they approve at all. Most if not all of these plans are basically HMOs. Don't try and get care out of network or out of the area you're enrolled in our you will end up with the bill.

And don't get really ill. Because at some point they will say you've reached your lifetime maximum and no more payments.

These things do not happen with traditional Medicare.

Yes, it's nice to have dental, vision and that gym membership. But I'll need health insurance for my heart bypass or all those expensive cancer treatments if I get that dreaded disease. I manage to pay for dental and vision out of my pocket and it's annoying Medicare doesn't cover that. (Medicare still pays for things like cataracts or retina tears etc.)

 

[SickOfTheOnePct]

34. Some plans may indeed

have all those problems. But not all do.

And original Medicare also requires prior authorization for some things.

People need to educate themselves and go with a plan that works best for them.

[Liberal In Texas]

58. Original Medicare DOES NOT ever require a pre-authorization.

All you have to do is check to make sure the procedure or medicine is covered, which it 99.9% of the time will be.

Advantage is private insurance. Run by big insurance companies. There is no way you're going to educate yourself to know if the insurance company will start denying coverage.

[Silent Type]

46. There is no lifetime maximum on MA. And original Medicare does deny claims and you do get

stuck with paying the providers. It’s handled differently, though. For example, Medicare will deny behavioral health, injections, physical therapy, knee and joint injections, etc., based on exceeding a set number of encounters. There are rules on how often you can have a colonoscopy, mammogram, etc.

Like prior authorizations, the provider has a chance to appeal the denial with additional info. Similarly, physicians learn quickly to delay many expensive treatments until conservative care is tried first because Medicare will audit docs who provided too many services years after the service is rendered.

Another interesting fact, while original Medicare is not allowed to negatively drug prices (until recently on a small number of drugs), Advantage plans can and do negotiate drug prices. Admittedly, the negotiations impact will be greater if both original and MA are negotiating.

I believe those that can afford original Medicare, a supplement, drug plan, and go without limited dental, food cards, etc., have more flexibility. But lots — 30+ million beneficiaries — can’t afford original Medicare. They should have that choice until Medicare is completely overhauled. Don’t see that happen anytime soon.

[Liberal In Texas]

59. Bunk.

Medicare audits if fraud is suspected. Audits the provider, not the patient.
https://www.thehealthlawfirm.com/resources/health-law-articles-and-documents/medicare-audits.html

Just get sick and see if there isn't a lifetime cap.

I have never heard of Medicare denying a claim. Ever.
Lets say you've had physical therapy and you have plateaued out. If you still really need it, you may have to get a doctor to write that it is medically necessary.

[Silent Type]

62. You are wrong. Besides, never said patient was audited. What a joke, Medicare

denies millions of claims, mostly because claim is screwed up, but also for non-covered or medically unnecessary services like a second blood test within a given time period.

[TxGuitar]

110. Medicare denies

Claims all the time for a variety of reasons. You can appeal. Medicare Advantage plans are overseen by CMS and there is far less fraud in Advantage plans vs traditional Medicare.

[former9thward]

114. Untrue.

I have a MA and never needed prior authorization for anything. I have seen anyone I needed to see promptly and faster than those I know who don't have a MA plan. If you don't want a MA plan and you like paying extra, fine. I will take the alternative.

[Ms. Toad]

52. There are very few states in which you can switch to regular Medicare AND get a supplemental plan

to cover the 20% that Medicare does not cover. I only know of one (Illinois - under Illinois law there must be at least one MA plan which offers the ability to switch with guaranteed issue and community rates to a Medigap plan).

In most states, although you can drop your Medicare Advantage plan and return to just parts A and B, insurers are not obligated to issue you a supplemental plan (the plan that covers part or all of the 20%). If they choose to offer you a plan, they are permitted to base it on your actual health.

In most states the one and only time to be guaranteed access to regular Medicare (which most people refer to as Medicare plus a Medigap plan) is during your initial initial enrollment period. Otherwise, even though you can opt out of MA, you generally cannot opt in easily (or at all) to a Medigap plan. I had to explan that multiple times to a colleague of mine who teaches administrative law, who read the same information you are reading. He did not understand it (or believe me) until after he hired an independent Medicare Specialist who confirmed exactly what I told him.

Remember, regardless of how much you like and trust the person who is handling Medicare for you, they are not your agent, they are the agent for the insurance companies - that is who pays them. That conflict is significant enough that they are typically required to have you sign a disclosure and waiver of conflict of interest in order to handle Medicare enrollment.

[LuckyCharms]

8. I look at things like this simply:

I don't choose a remodeling contractor that advertises heavily.

Along the same lines, I would not choose a Medicare advantage plan over traditional Medicare.

Any organization that advertises with extreme, obnoxious frequency is not doing it because they love you.

[dalton99a]

61. +1. They are spending a stupendous sum to take over the system

[Rebl2]

10. Thank you

for this information. I was warned by my rheumatologist several years ago about Medicare advantage and how they would more than likely not pay for my biologic drug I take. Also had someone from United Healthcare tell me several years ago, stay on the federal plan from post office I have for my supplemental when I turned 65. He said stay on it as long as you can because of the medication I take. Thought that was interesting.

[KS Toronado]

11. The biggest "Hidden Danger"

is what these insurance companies will do to your pocketbook that Medicare would not.

[OMGWTF]

12. How these Advantage programs are able to use "Medicare" in their name is an outrage.

Another legacy of that fking moron and war monger GeeDumbya Bush.

[Silent Type]

17. Actually it was Clinton's Admin the approved what was simply called Part C in 1997.

[LiberalFighter]

28. Advantage plans consist of Medicare paying 80% of covered costs.

And the advantage paying 20% of covered costs. Costs differ on deductibles, copays, etc.

[William769]

30. As long as it's in the advatage plans network.

Thats where they get you.

[LiberalFighter]

88. Maybe for plans open to the general public.

The advantage plans we have are going to be more careful when they can lose accounts involving over 800,000.

[dpibel]

73. You sure?

That sounds like Medigap.

Advantage is a capitated system--there's no cost-split with Medicare.

[LiberalFighter]

87. I have a Medicare Advantage plan that is overseen by a group committee.

Advantage plans manage it. Medicare still pays what original Medicare covers and the balance which is 20%.

We have over 800,000 in the plans. And our plans are not available to the general public.

[Ms. Toad]

72. They are Medicare plans - they fall under Part C of the Medicare laws.

They still fall under the Medicare laws for what is covered. Drug coverage still (at least by default) includes the donut hole.

But they are allowed to save money by addding gate-keeping - such as pre-approval for certain procedures, step coverage (where you have to try a lower tier treatment before you are permitted to try a higher tier), etc. (which doesn't exist in any significant form in Medicare), they are allowed to limit the geographic region in which your care is covered, they are allowed to limit you to a network of medical providers within that geographic region.

[DownriverDem]

15. It needs to be fixed then.

My husband just got his crown paid for with BCBS of Michigan Medicare Advantage PPO. I have the same plan. I pay $0 per month not like a Supplemental Plan would be. We need M4A (Medicare for All) then.

[Delphinus]

43. John Conyers

(I think I remember his name correctly) was in the early 2000's a huge proponent of HR 676 Medicare for All.

I really thought when President Obama was elected, we might have a good chance of getting that.

[DownriverDem]

91. You need Congress

to make M4A a reality. My point is that a lot of folks would not be able to pay a monthly fee for a Supplemental Plan. It doesn't include prescriptions either. For now how could folks fault others who like the MA benefits?

[70sEraVet]

18. We've been on Medicare A and B, and have a supplemental.

Not cheap, but it has worked out well for us. I have an uncle who is on a Medicare Advantage plan, and he has run into a problem of needing a surgery, and having difficulty finding a surgeon who will accept his insurance.
Is that a common problem?

[Mossfern]

37. We have the same

Medicare A and B with AARP United Healthcare supplemental.
It works for us. The only place where the coverage is inadequate is for mental health issues.

[bahboo]

19. haven't had any issues with my Advantage plan yet...

and I've had a couple of pricey procedures due to afib. Love my cardiologist....

[wryter2000]

22. I don't think loving your specialist is relevant to the question

I love my nephrologist, but I don't credit my Kaiser insurance for that. He'd be as great as if I found him somewhere else.

[bahboo]

23. what is relevant, is that he's part of my plan...

and recommended by my PCP.

[wryter2000]

25. Okay.

I never have to think about that.

[CrispyQ]

102. I love my Kaiser Advantage plan that cost me nothing.

I live in a Kaiser rich environment, though, but I love it. You can almost always get in to see someone in a day or two even if it's just a plugged ear. I could pay more, but the default plan is good for me.

[Skittles]

20. they omitted the biggest reason

the entire scheme is to eventually get rid of Medicare

[wryter2000]

21. The Federal Government should make them take the name Medicare out of it

Even an educated person would assume you're just reallocating your traditional Medicare in a different way. Most people aren't aware they'd giving up their Medicare when you sign up for one of these plans.

I so want to throw something through my TV screen when one of these commercials comes on.

[MichMan]

36. Who is "them" ?

The Federal Government;'s own Medicare website calls these plans "Medicare Part C" and lets people sign up for them there.

[SWBTATTReg]

24. Forgive me if I'm mistaken, but I thought that perhaps Congress was looking at these Med. Advantage

plans, to address some of the pitfalls that some are facing. Is this effort still underway?

[wryter2000]

26. If Republicans were looking at it, I'd beware

I wouldn't trust them to recommend a brand of toilet paper.

[AZ8theist]

92. Toilet paper?

The only Repuke brand of recommended TP I would consider is ones with Doturds face on every sheet.

Come to think of it, I would buy that even if the fascist pukes didn't recommend it!!

[LiberalFighter]

27. Several days ago started getting 30 or more calls a day.

Today started telling them I don't have A or B. Or I tell them I am 40 or under.

[LetMyPeopleVote]

29. I get a ton of calls on these advantage plans and hang up on the scam artists pushing these plans

As a partner in my law firm, I have to bear the entire cost of my health insurance and as soon as I turned 65 I switched to Medicare. Several members of my firm use a consultant who is also a member of my temple for advice and he recommended a Schedule G supplement plan and a drug plan. I am now paying one-third of what I was paying for my prior coverage.

Advantage plans are scams. Stay away from them.

[MOMFUDSKI]

39. So what is the grand total you pay per month?

The point I am trying to make is I had a neighbor that was pumping out $400/month between her supplement and what they withheld from her SS check. She was living on $1000/mo and was 81 at the time. Had been paying like this since she turned 65. I explained the Advantage Plan to her and she finally understood it and switched. Some people just can't afford a supp, SS withholding, and drug plan. Be thankful that you can. Bottom line is our government should provide for people over 65 as if they had National Health Care. When you have a widow forced to live on $600/mo due to healthcare premiums that is shameful.

[dpibel]

50. Amazing how this is ignored

In all of these articles about the Advantage "scam," the answer is so simple: Trad Medicare plus supplement and, oh yeah, drug coverage. If you don't do it, you're a sap.

And they could be right about this all being an evil scheme to destroy Medicare.

That does not change the fact that the median income for households 65 and up is a bit more than $50K. That means there's whole lot of people living on less than that.

Saying, "Don't be duped by Advantage! Just shell out the three or four hundred to do the right thing. What's so hard about that?" borders on cruel.

[LetMyPeopleVote]

98. I am paying over $325 or so month between the three plans

I am still working and these plans are much cheaper than the firm insurance that I had to pay the full premium as a partner. My firm has a paralegal who is eligible for Medicare but is still on the firm insurance.

[dflprincess]

31. As I've said before,

Ask yourself why the insurance companies push Advantage Plans and rarely mention supplements & drug plans.

Hint: it's not because they love us and want us to be healthy.

[dpibel]

54. Supplements are for profit, y'know

It's not as if Medigap and Part D are charitable donations.

May well be that Advantage is more profitable. Doesn't change the fact that the supplemental coverages are expensive and profitable to the insurers.

[dflprincess]

64. Clearly not as profitable or they would be pushing them as hard as they do Advantage plans

At least in my area I have the option of choosing from several non-profit companies to pick my supplement from when I finally pull the plug and retire. Not that it won't be over priced but my experience, having been insured by both profit and non-profit companies, is that the non-profits don't play as many games when it comes to paying claims.

[dpibel]

71. My Advantage is not-for-profit

Where does that leave us?

[dflprincess]

74. You are fortunate then

I know several people who signed up for the AARP advantage plan which is operated by UnitedHeatlh Group where share price is everything and avoiding paying claims is the name of the game. The plan will be fine until they really need it.

(Twenty years ago I worked there - nothing makes a person a believer in single payer faster than working for UHG.)

[dpibel]

76. As I said elsewhere in this thread

I'm waiting for anyone, ever, on any of these threads to say, "Yes! I was victimized by Medicare Advantage."

At this point, even if I finally see one, I'm going to say, "That's one out of thousands of people who have read these threads on DU."

I just have to believe that if MA were so terrible, we would not have these many, many "Watch Out For The Advantage!!1!" threads with nobody giving a first-person account of their brutalization at the hands of the avaricious Advantagers.

Don't get me wrong: I've been arguing for universal single-payer for decades. I think the current medical system in the US sucks bigly.

I'm just having a hard time squaring the alarmism about Medicare Advantage with the fact that the worst anyone can provide in these threads is "I knew some people..."

[brush]

79. Right. If IIRC Medicare part A&b pay 80%, the rest is up to you...

which is where and why the advantage plans (part C) came about. They cover much of the remaing 20%.

Pls verify though on Medicare's website.

[Freddie]

33. My daughter is an RN Case Manager for home care

She HATES the Advantage plans. The bean counters love to cut off care when the patient still needs it. These are elderly people discharged from the hospital after surgery. DH and I just went on Medicare and took her advice to get Traditional with a supplement (AARP). So far so good.

[TxGuitar]

111. Not bean counters

Likely nurses as case managers. And the reason home health doesn't like Advantage plans is that the home health agency has to show the client is meeting goals. Home health care agencies are known for milking Medicare. Wife was a director of nursing for several home health agencies and she was appalled at the needless recertification for clients. It is all about money

[Progressive dog]

35. The medicare.gov web site

will show you comparisons on costs of all MA policies available in your zip code. The comparisons will include original medicare. My cost sharing for primary care is zero and for specialists it's a fixed $40 per visit.
Rather than listening to a retired health care executive, I would suggest you check for yourself.

[William769]

38. I have checked for myself.

All their networks are worthless.

All advatage plans are HMO's and they are out for one thing only, to make money.

One more thing, good luck finding specialists in my area that will take advantage plans.

[Progressive dog]

40. "All their networks are worthless"

Obviously you haven't checked or you would know that there are PPO's available. I have yet to find any doctor in my area who doesn't accept my plan.

[pazzyanne]

56. William769,

All Advantage plans are not HMO's. I have had an Advantage PPO plan for over 20 years and love it. The cost of my Medicare plus Advantage plan is $244.80 a year at this time and includes Medicare Part D (medication), dental, and vision. I work with 2 excellent specialists who are in network, with no problems.

[TxGuitar]

113. It does depend on where you live

Rural areas will obviously have less coverage in terms of choice. My wife's plan has 1200 primary care doctors and 7200 specialists alk in the area. No need for prior auth for anything. We live in a major metro area. KelseyCare

[MOMFUDSKI]

41. Also the Medicare.gov website will find plans available to you based on your medications.

It is always about your medications. That is the starting point.

[AverageOldGuy]

44. Just dropping this story here . . .

I'm 79 and live in a waterfront community, rural VA, Chesapeake Bay. I'm an EMT and still serve with the local volunteer rescue squad, though I answer only a few calls per month because EMS is a younger person's job.

One of my neighbors is 73, divorced, somewhat reclusive; ex-husband lives about 20 minutes away, he visits her almost every day, they get along well, he is 78.

Three days ago he called me about 9:00 PM. Seems that he had been trying to call her for three hours, no answer, could I go check on her. I grabbed my medic bag and squad radio, called the dispatcher and requested they put a deputy enroute in case I needed to make forced entry. Arrived at the house, dark, all doors locked, I could see the flicker of a tv set in one room. Shined my flashlight through the windows, saw her lying on the floor. Did not wait for the deputy -- called for medics and an ambulance, kicked in the front door. She was dead -- unconscious, unresponsive, not breathing, no pulse, no chest sounds, pupils fixed and dilated, cool to the touch, obvious lividity. Nevertheless, I started CPR, medics arrived, we tried one round of CPR and AED, called ER doc who told us to declare her dead.

Husband arrived shortly after. I talked with him for some time . . . he became more and more agitated as we talked. He said she had all but stopped seeing docs for her various ailments because two years ago, against his advice, she had dropped Medicare for a Medicare Advantage plan -- "because of all those damn TV ads" -- that had denied almost all her requests for meds, specialists, and the like. She could not afford the co-pays or the medication.

Not saying she would have been alive had she stayed with traditional Medicare, it could be a bit more complicated -- just dropping this story here for what you may take from it.

[meow2u3]

45. I'm keeping my original Medicare

I also have a secondary insurance as a disabled dependent in my deceased dad's name; he was career Army.

[dpibel]

53. What are the odds?

As I write this, this OP has been viewed 2,031 times. Now that of course does not mean it's been viewed by 2,031 people. But let's be conservative and say that those views represent an even thousand people.

The information in the article linked in the OP is, as are articles from Thom Hartmann and Wendell Potter, and the regular OPs on the subject, a dire warning that if you get into Advantage, you are toast, sucker.

Here's the thing: People on this website are not shy. They are not inarticulate.

If Medicare Advantage is such a total rip, why is there not a single post on this thread, or on any thread, with actual firsthand endorsement of the "killer Advantage" meme?

There is in this thread a person who says they were warned off Advantage because of a special medication.

That's as close as we get. And that's really not a "Medicare Advantage screwed me big time" story.

The other factual claims in this thread, and in all the others like it, is "this guy I know/my uncle/a grieving ex-husband/my niece told me about this horrible problem."

If it's all a scam, where are the first-person testimonials to that?

Instead, you get a few brave souls who say, "I've got Advantage, and it's done me just fine." They are then, as a rule, told "You just wait!" There are even people who say, "I've had surgery, and it cost me a little bit of nothing." But that seems not to count.

Really: A thousand people have read this OP, and there's not a single one with a horror story? How does that work?

[hunter]

99. Selection bias. Those who failed to navigate the system are not posting on DU.

Some of them are dead.

The health care "system" in the U.S.A. is garbage. Severely ill people who don't have strong advocates are frequently shit out of luck, especially if they are some lonely person who has been bamboozled by television advertising or slick telemarketers pretending to be their friends.

Other nations have health care systems that actually work with lower costs and superior medical care. We should be emulating those.

Even people with "platinum insurance" and million dollar checking accounts frequently suffer crappy, inappropriate, and even dangerous health "care" here in these United States.

[dpibel]

106. Can't disagree

It's not really a response to my question. I'm not quite buying that there are quite a number of people who have survived Medicare Advantage long enough to post that they're happy with it, but all the people who are screwed by it die before they can ever post.

But it is beyond argument that the US has the worst health care system of any industrialized country. A Canadian-style system would save money and produce better results.

A big part of the problem is that decoupling medical insurance from employment deprives employers of a big piece of leverage.

[hunter]

108. I didn't claim they are all dead...

... only that they are not likely to be posting on DU. They might not have any internet access at all.

[thesquanderer]

105. Another kind of selection bias...

DU is presumably populated disproportionately by people who think government-run non-profit programs like Medicare are a good thing. If you had the same discussion on Free Republic, I suspect you'd get more replies from people who think MA is the way to go, because conservative republicans tend to think it's better to privatize these kinds of things.

[JenniferJuniper]

107. First hand experience

My father had a Medicare Advantage plan and paid a fair amount for it. A BCBS plan, IIRC.

He had dementia and ended up needing surgery during the early days of the pandemic. In his late 70s. His doctors wanted him discharged to a rehab facility. The hospital was in the process of trying to get him out. His dementia was worsening post-surgery.

My siblings and I could not find a facility that would take him. I didn't understand why at the time, but I learned that he was being rejected because the rehab places preferred people without Medicare C due to their frequent arbitrary coverage restrictions and denials. He ended up 2 hours from the closest relative and died (we believe from neglect) with a few weeks of arriving.

My sister has since become a discharge nurse and she says this is very common. According to her, it's very difficult to place patients post-hospital stay with Advantage plans as opposed to those with traditional A & B.

I think Medicare C plans might be okay for younger, healthy people. But as people age, it becomes riskier. It's very important to keep in mind that these are for-profit plans and coverage restrictions and denials boast profits.

[JayDem]

57. Just to clarify

You, William769's, are correct in your advice to avoid Medicare Advantage plans. The only corrections necessary are that these plans do not really give providers the payment certainty stated, and they do not really give CMS certainty either. In fact, these plans cost CMS (the stewards of the Medicare Trust Fund) significantly more money than having the services just provided through the Traditional Medicare program. Whether you are talking on the Micro or the Macro level Medicare Advantage programs are clearly Medicare (Dis)advantage programs.

[NewHendoLib]

60. This is not strictly correct. Everyone has to take Medicare A (which is free) and B.

There are two options for part C - the Advantage plans, and supplemental plans. It is the Advantage plans that are heavily advertised. The Supplemental plans are listed and can be compared on State Department of Insurance sites. You must have a part C option to cover that which part B does not cover.

[dflprincess]

69. Part C is strictly Medicare Advantage

If you stick with traditional Medicare parts A & B your are advised to get a supplement or "Medigap" policy to cover what parts A & B don't.

Medicare Advantage plans are strictly private insurance & really shouldn't be allowed to use "Medicare" in its name at all (we can thank the GW Bush administration for that piece of false advertising). At least two of the larger clinic/hospital systems in my area have announced they will no longer accept Humana Medicare Advantage plans, my friend just received a letter from Mayo Clinic in Scottsdale, AZ reminding her that it does not accept any Advantage plans (I believe Mayo in Rochester, MN does). I am not aware of any that refuse Part A and Part B.

MA will probably work okay until the insurance companies have succeeded in destroying traditional Medicare, then watch the premiums rise while your claims are denied.

[NewHendoLib]

70. That was the point I made poorly but you did much better!

I did a better job here - https://www.democraticunderground.com/100218424642

[brooklynite]

65. What does this have to do with Social Security?

I go on MedicareT 65. I won’t claim Social Security until I’m 70.

[brooklynite]

66. Who is Michael J Krivich and why should I rely on his opinion?

[airplaneman]

67. Whoever is selling Advantage gets $750 per sign up as compared to 0 for traditional Medicare

I get it for someone who cant afford the B / D / G as they run about $4K per person per year. The risks of Advantage if you get very sick or need nursing care for 100 days are huge. If you are health it may seem like a good deal. The $750 is making a lot of people greedy IMHO.
-Airplane

[PoindexterOglethorpe]

75. I have an Advantage Plan.

I pay zero extra for it and it covers everything, so far as I can tell.

Three years ago I had a heart attack, spend three days in hospital, wound up paying something like $700 for a bill that totalled over $70,000.

More recently, I fell and broke an arm and the ER visit was at least $5,000, and I only paid $25 co-pay. And another $25.00 co-pay when I got back home and had it looked at here by an orthopedist.

Yes, I typically have a $25.00 co-pay when I see a doctor. I have not had my Advantage Plan refuse to allow me to have an echo-cardiogram, or more recently, a bone scan to see if at my age (75) I have any bone thinning.

My three prescription medications no longer have any co-pay at all, but I think that's more of something President Biden did than Medicare or Advantage Plan.

I'm sure that Advantage Plans vary widely, and that some are much better than others. The same with any other kind of health care plan a younger person might have.

[greatauntoftriplets]

77. I can't tell you how many healthcare providers have told me to avoid MA.

When I called Blue Cross/Blue Shield of Illinois to sign up for coverage with Medicare, all the rep could talk about was Advantage plans. I kept telling her that I didn't want one of those, I wanted a regular supplement plan.

She wouldn't shut up. Eventually I talked with friends and family about what they had, got information on the various plans, and then signed up for it.

I do know people who love their MA coverage. Ironically, there's a commercial for it on my TV right now. Not Martha.

[brush]

78. IIRC Medicare parts A & B pay only 80% of costs. The rest is on you...

which is where the advantage plans come (part C), they help with the last 20%. And there are different part C plans, taken out of your SS monthly benefit.

Of course it's best to verify at the SS website.

[ashredux]

80. Remember, there is no free lunch. Period.

If one gets dental, etc. additional coverages, they are not free. You may see your good initial pricing, but the devils in the details. Do not do it. Medicare advantage is a scam and the insurance companies are making a ton of money off of it.

[Emile]

81. Advantage plans were introduced by republicans

to replace Medicare.

My brother has leukemia and is on an Advantage plan. He was just denied a life saving surgery, was kicked out of the hospital and after one week in a nursing home is again fighting the Advantage plan because they want him out of the nursing home.

[LuckyCharms]

82. Best wishes to your brother, and to you, Emile.

[Emile]

84. Thanks LuckyCharms.

[Emile]

117. The doctor at the nursing home last week

put in an appeal that my brother was not ready to be released. He is incapable to stand on his own and still very sick. He won the appeal and now they are going through the same thing this week. So I guess every week they have to appeal the Advantage plan and hopefully they keep winning or he will be kicked out. The hospital in Little Rock was going to do surgery and his Advantage plan cancelled that and after two months kicked him out of the hospital. People if you're on an Advantage plan, get off of it because they're only going to get worse.

[LuckyCharms]

118. So sorry he has to go through all of this.

[leftyladyfrommo]

83. I have Humana Advantage Plus. It's been

wonderful. I have no complaints.

[SouthernDem4ever]

85. Thanks for the info and discussion about Advantage plans

a lot of useful info here.

[Pugee]

93. As a retired medical social worker

I agree wholeheartedly. I cant count the times I had to tell seniors that their Advantage plan would not cover basic services and had to watch them choose to do without. Or the hours I spent on the phone trying to get them back on Medicare, usually unsucessfully.

[NewEnglandAutumn]

94. Another issue that needs to be addressed

You can use manufacturer's drug coupons for most plans EXCEPT with government plans and all part D plans are considered gvt. plans. This means if you are prescribed an expensive (and yes often more effective inhaler ) you can not use any discount programs.

It is a catch 22 these programs only work if you have other insurance and they can pick up the remainder bringing down copays to as little as 10 dollars for everyone who has insurance except those who often need them the most.

Don't even get me started on the 'doughnut hole'.

Part D plans are much better than nothing at all but the loop holes are destructive to many older people.

[Silent Type]

116. I think the donut hole ends next year or 2025. And Biden's legislation will have like a $2,000 cap

on your out-of-pocket costs. If I have it right and GOPers don’t try to change the legislation, it will greatly improve drug plans.

[TxGuitar]

95. My spouse has a great plan

She is a retired RN and spent the last 10 years as a case manager for Medicare/Medicaid recipients in the community. Her plan is a 5 star plan and has been for the past 7 years Kelsey Advantage. Her out of pocket expenses have thousands less than mine with an employee sponsored plan. Now, she is healthy and only has one prescription. With traditional Medicare you are responsible for 20% and you have to have a drug plan. Medical plans cost 150. Per month and more. There is no one plan fits all and everyone needs to do their own research. She does not foresee ever changing to traditional Medicare unless something drastic happens. Also, Medicare for All (if that ever happens) will almost assuredly be based on the advantage plan model. Also, apparently unknown to those not on Medicare or those about to be for most of us Medicare costs 175.00 and more per month.

[sl8]

96. About the $175/mo.

Are you talking about tbe Part B premiums? You're still required to pay that with Medicare Advantage.

[TxGuitar]

97. Yes

Of course she knows that. As I said, she was a very experienced RN case manager for many years. I was just pointing out that many people think Medicare is free, which it is not whether trad Medicare or Advantage. Plus she sees it deducted from her check every month.

[totodeinhere]

100. I have found that simply paying for a good Medicare supplement plan

is a better idea. I would not want to enroll in a Medicare Advantage plan.

[TxGuitar]

109. Many cannot afford Medigap p!ans

They cost around 150 and up per month. Everyone needs to do their own research to find the best option for themselves.

[totodeinhere]

112. Mine costs $430 monthly but I have no deductibles or copay's

so I think it's worth it. It's unfortunate that some people can't afford it but that is a consequence of our broken healthcare system which needs to be changed.

[thesquanderer]

101. Not a surprise that a system whose primary goal is profit for private companies...

...ends up being worse for consumers overall than a non-profit system whose primary goal is health care.

[dlk]

104. Medigap Policies are an excellent option, especially for retirees with needing a high level of medical care, however...

Outside of the initial election period, when a retiree turns 65 or unless there is a special election period, such as losing employer coverage, retirees are subject to medical underwriting and there's no guarantee for the premium. The insurer has the option of rejecting the application altogether. Two states, New York and Connecticut, have year around guaranteed issue, and a very few other state have birthday rules for guaranteed issue. However, outside of these limited periods, it is difficult to enroll in a Medigap policy outside of the initial election period when turning 65. Medigap premiums are based on age, inflation and increased insurer costs, and the premiums increase over time, some times significantly. It's not uncommon for older retirees being forced to move from Medigap to Advantage because they can no longer afford the Medigap premiums.

Medigap policies are great in that they allow the retiree to see any provider in the US that accepts medicare without a referral and there are no prior authorizations.

Medigap policies were designed to fill in the gaps for original Medicare Parts A and B. However, there is no prescription drug coverage with a Medigap policy and in order to meet the Medicare requirement for Part D coverage, a separate, standalone Part D prescription policy is required. In fact, Medicare assesses lifetime penalties if a retiree is not enrolled in creditable prescriptions coverage when first eligible for Medicare.

Original Medicare does not cover dental, hearing or vision benefits for eyeglasses. Separate policies are required for their coverage.

Ideally, a Medigap policy is the best way to obtain the best medical coverage after age 65. However, may retirees aren't aware of the guaranteed issue limitations for enrollment and miss this opportunity during their initial election period. Without the guaranteed issue benefit, a retiree is subject to medical underwriting and the insurance carrier has the option to reject the policy. If the insurance carrier decides to write the policy, the premium will be based upon the retiree's age and health status.

Medigap policies are generally the best option for retiree needing a high level of medical care, since the out-of-pocket costs are loser. However, Advantage is a viable option for retiree who are generally in good health and don't require a high level of medical care. They are also a viable option for retirees without sufficient financial resources to afford the premiums for a Medigap policy, plus a Part D prescription policy, along with dental, vision and hearing policies.

Advantage is far from perfect, however, given the current Medicare system, it is a viable option for many retirees. Medigap policies are generally the best option for retiree needing a high level of medical care, since the out-of-pocket costs are loser.

Advantage is a viable option for retiree who are generally in good health and don't require a high level of medical care. There are many low or $0 premium policies available, and there is a medical out-of-pocket maximum for every policy. Advantage plans have networks, HMO's and PPO's, and a primary care physician is required. The out-of pocket costs are higher for Advantage than for a Medigap policy. but many of the plans offer dental, hearing and vision benefits, as well as gym memberships and other benefits.

All of the Medicare plans are available to be viewed on the Medicare.gov website and have star ratings from one to five stars. Medicare does the star rating annually, based on quality and performance It makes sense to review the rating on the Medicare.gov site and select a plan with a high star rating

With both Media and Advantage plans, the retiree has the right to file appeal plan decisions, as well as file grievances about the plan, quality of care, doctor, provider, or hospital. Grievances can be filed with the insurance carrier or directly with Medicare.

Of course, there are bad actors in every insurance area. It pays to be a proactive consumer and do the research. Until there are major changes to the Medicare delivery system, Advantage plans offer a viable (if not perfect) option for many retirees, despite the warnings in earlier posts.

[milestogo]

115. I have a plan that covers prescriptions for about $35/month.

Its a good deal. BUT, they keep calling and trying to upsell me, which is really annoying. The idea is to make you feel like you are missing an opportunity, or missing a deadline, when in fact they are just after your money. Its tiresome.

[elocs]

120. Since I am poor, below the 100% FPL, I have dual coverage with both Medicare and Medicaid.

An Advantage plan is the only thing that helps me to survive and if all I had was traditional Medicare I'd be screwed with my pants on and I'd be a fool not to have it.